Almost 100 GP practices closed in the UK in 2019, new figures collected by Management in Practice’s sister title Pulse show, with GP leaders warning that Covid-19 could prompt even more to shut this year.
The 99 closures last year, which included whole practices, branch practices and closures as a result of mergers, meant nearly an estimated 350,000 patients were forced to move to a new surgery.
It continues an ongoing yearly trend of large numbers of GP surgeries shutting – up from just 18 in 2013 when Pulse first started tracking the issue.
How practice closures declined but remained high in 2019
The 2019 data, collected from responses to freedom of information (FOI) requests sent by Pulse to all CCGs and health boards across the UK, show there were fewer closures than the 138 seen in 2018.
GP leaders said contract changes in England in 2019, which saw extra funding channelled through primary care networks, may have helped stem some closures last year as it provided some financial stability.
But they warned they expect to see far more practices shutting in 2020 due to the Covid-19 response, which ‘poses new threats to viability’.
The latest workforce figures from NHS Digital show the number of full-time-equivalent GPs in England is continuing to fall – dropping by 651, from 28,256 to 27,605, between June 2019 and June 2020.
Wessex LMCs chief executive Dr Nigel Watson said an increase in funding to hire more clinical staff and the formation of primary care networks as part of the 2019/20 GP contract in England had only temporarily reassured some practices about their future.
He said: ‘The additional roles funding has been a catalyst to get practices to work together, and in some cases PCN practices realise that if one falls over it will have a negative impact on all the others – so some mutual support has happened.’
But he warned: ‘I think it’s quite possible we will see more [closures] unless we continue to support general practice.’
Londonwide LMCs said it had seen high levels of GPs nearing retirement and large numbers of vacancies in the capital over the past four years. Pulse’s data show the capital suffered 18 closures in 2019, affecting an estimated 61,000 patients.
Dr Michelle Drage, chief executive of Londonwide LMCs, said: ‘Throughout this time we have consistently found that a third of practices are carrying GP vacancies and two-fifths have impending retirements – the workforce crisis that threatens the stability of so many London practices is not going away.
‘The coronavirus response poses new threats to viability, with infection-control measures and increased demand further stretching resources, and lack of full reimbursement of pandemic-related expenses squeezing finances.’
BMA GP Committee workforce lead Dr Krishna Kasaraneni added: ‘There are added challenges of the Covid-19 pandemic, which we could expect to be reflected in the practice closures figures for 2020. Through this, practices have worked tirelessly to maintain services for their communities.
‘With a possible second Covid spike and the onset of a major flu vaccination programme imminent, practices are looking for guarantees that additional resources from NHS England will be forthcoming.’
NHS England said the creation of PCNs had helped slow the number of practices shutting last year, while health departments in Scotland, Wales and Northern Ireland highlighted efforts to increase GP numbers and improve support for practices.
An NHS England spokesperson said: ‘While this represents a very small proportion of practices, in some cases surgeries have merged with a nearby practice and in other cases a partner may have retired.
‘The expansion of primary care networks is ensuring greater availability of the right kind of appointment for patients – whether face to face or remote – and support for constituent practices.’
A Scottish Government spokesperson said: ‘We now have a record number of GPs working in Scotland with more per 100,000 population in Scotland than the rest of the UK. We are also committed to increasing the number by a further 800 over the next decade and to investing £250 million in direct support of general practice by the end of the current parliamentary period.’
They added: ‘The trend over a number of years has been towards fewer, larger practices but this does not mean a reduction in service. Patient safety is always the priority when a change to practice provision is proposed.’
A Welsh Government spokesperson said: ‘As is the trend across the UK, we expect to see a shift towards larger GP practices, with a wider skill mix of healthcare professionals in one setting, providing a greater range of healthcare services locally.
‘Since the launch of our “Train Work Live” campaign, we have significantly increased the number of GP trainees – the number of new GPs training in Wales has increased by 13.5% since last year and by 58% since 2018.’
A Northern Ireland Department of Health spokesperson said: ‘In 2019 two GP practices were taken over by other local practices and one practice closed with the patients being assigned to a number of practices in the local area.
‘Three practice mergers also took place, ensuring longer term sustainability and offering patients an increased range of services through access to a multi- professional workforce, including new roles such as practice based pharmacists and advanced nurse practitioners.’
A recent FOI investigation by Pulse found CCGs have been sitting on millions of pounds of unused additional roles funding after PCNs struggled to recruit in 2019/20.
Meanwhile a separate FOI investigation by Pulse found GPs in England had so far been reimbursed an average of less the £2 per patient for Covid-related costs.
A version of this story first appeared on our sister title Pulse.